Zepbound and other weight loss drugs (1 Viewer)

[Zow]

So we just go to our GP and ask for this?

I'd qualify under your BMI model quite easily.

You can certainly let them know you’re interested. They should counsel you on appropriate diet an exercise first, and encourage you to pursue an earnest trial of lifestyle modification.

Generally you should fail that before it’s prescribed, though I think there’s a good argument to use these meds to kick start the program.

Assume they've don't that, oh I dunno... 7 or 8 times at each of my last 7 or 8 yearly physicals?

 

[Terminalxylem]

So we just go to our GP and ask for this?

I'd qualify under your BMI model quite easily.

You can certainly let them know you’re interested. They should counsel you on appropriate diet an exercise first, and encourage you to pursue an earnest trial of lifestyle modification.

Generally you should fail that before it’s prescribed, though I think there’s a good argument to use these meds to kick start the program.

Assume they've don't that, oh I dunno... 7 or 8 times at each of my last 7 or 8 yearly physicals?

Did they really though? Like discuss dietary strategies, focusing on specific foods to seek out/avoid? Or review exercise type/frequency/intensity goals? Refer you to a nutritionist/weight management program?

Too often, these areas are shortchanged in contemporary medical practice, and vague encouragement to “eat better” and “exercise more” rarely makes a difference.

Off that soapbox, yeah, you should ask about Mounjaro/Zenpep your next appointment. Dedicate a visit for it.

 

[AAABatteries]

So we just go to our GP and ask for this?

I'd qualify under your BMI model quite easily.

You can certainly let them know you’re interested. They should counsel you on appropriate diet an exercise first, and encourage you to pursue an earnest trial of lifestyle modification.

Generally you should fail that before it’s prescribed, though I think there’s a good argument to use these meds to kick start the program.

Assume they've don't that, oh I dunno... 7 or 8 times at each of my last 7 or 8 yearly physicals?

Did they really though? Like discuss dietary strategies, focusing on specific foods to seek out/avoid? Or review exercise type/frequency/intensity goals? Refer you to a nutritionist/weight management program?

Too often, these areas are shortchanged in contemporary medical practice, and vague encouragement to “eat better” and “exercise more” rarely makes a difference.

Off that soapbox, yeah, you should ask about Mounjaro your next appointment. Dedicate a visit for it.

Serious question - what percentage of people do you think genuinely don’t know the stuff you mentioned? I’m genuinely curious - it seems unfathomable to me that there’s still people who don’t know but maybe you are thinking great detail like which cooking oils are good vs. bad, etc. Either way, I’m curious your thought on it.

 

[Doug B]

Serious question - what percentage of people do you think genuinely don’t know the stuff you mentioned?

Not a medical provider ... but I would think lack of knowledge is almost never an issue with obesity.

Instead, it seems obvious (without medical training/schooling but as an obese person) that obesity is a multi-factorial affliction -- one's physiological makeup seems to have a large effect. Off the cuff, there also seems to be multiple distinct psychological components (e.g. pleasure-pain/reward 'system' is off or 'hijacked', exercise doesn't yield [sufficient?] endorphins, etc.).

I do know (or rather 'know', because there's likely to be well-supported contrary info out there) that there are a good number of people -- maybe 1 in 5 Americans, maybe more -- that could work out like a triathlete, live on kale, and go get lost in the Andes for a year ... and would still end up having what amounts to a 'Dad bod + beer gut'. And there are also some amount of people that could eat three Thanksgiving dinners every day, lie around on the couch binging Netflix 24/7, and they'd never put on an ounce -- instead, they'd feel nauseous all the time (and probably vomit more than they'd like) from all that excess food their body can't process in some manner (read: digest for nutrients or store as body fat).

Sigh.

Starting off obese ... and looking to get in some kind of quasi-shape ... that's a big freackin' mountain. It ain't just diet-&-exercise for a little while and you're good. Lifestyle changes? Forever? What? How many of us are really in for that? How many of us can really bootstrap that out of our psyches? And even if you can, you're pretty darned exceptional ... and can you really expect that one-in-a-jillion exceptionality out of all obese people?

Needless to say, there's a lot to work through before you even get to the 'diet & exercise' platitude. Bring on the drugs.

 

[Battersbox]

Been on compounded semaglutide for 9 mos. It's life changing. There is no question in my mind this class of drugs can meaningfully improve the overall health of our populace. Hopefully unforseen side-effects aren't forthcoming, but we'll see. To me the risk/reward is clearly worth it considering people have been taking these for over 15 years.

I also understand most people's initial reaction to these is to say 'there are no shortcuts, drugs never work for weight loss long term'. What they typically fail to understand though is these are behavior-modifying drugs...you don't take a drug and magically lose weight. You take a drug and it helps you change your lifestyle, which helps you lose weight.

 

[Terminalxylem]

So we just go to our GP and ask for this?

I'd qualify under your BMI model quite easily.

You can certainly let them know you’re interested. They should counsel you on appropriate diet an exercise first, and encourage you to pursue an earnest trial of lifestyle modification.

Generally you should fail that before it’s prescribed, though I think there’s a good argument to use these meds to kick start the program.

Assume they've don't that, oh I dunno... 7 or 8 times at each of my last 7 or 8 yearly physicals?

Did they really though? Like discuss dietary strategies, focusing on specific foods to seek out/avoid? Or review exercise type/frequency/intensity goals? Refer you to a nutritionist/weight management program?

Too often, these areas are shortchanged in contemporary medical practice, and vague encouragement to “eat better” and “exercise more” rarely makes a difference.

Off that soapbox, yeah, you should ask about Mounjaro your next appointment. Dedicate a visit for it.

Serious question - what percentage of people do you think genuinely don’t know the stuff you mentioned? I’m genuinely curious - it seems unfathomable to me that there’s still people who don’t know but maybe you are thinking great detail like which cooking oils are good vs. bad, etc. Either way, I’m curious your thought on it.

I gave a nutrition lecture to inner city kids, like 4th grade or so. At that age, they had no clue, basically always picking the less healthy food choices presented to them. It was shocking how little they knew.

Adults should be more informed. I’m guessing a large majority knows eating fruits and vegetables is desirable, and sugar sweetened beverages are bad. Beyond that, I‘m not so sure, as really healthful foods like legumes and whole grains have been demonized by some contemporary diets, while relatively meaningless designations like “organic” and “grass-fed” are sought out. Meanwhile, established disease risk factors like salt content are an afterthought.

Add in controversy about macronutrient composition and fasting, and I bet most people could benefit from some nutritional counseling.

Admittedly, nutrition is a murky science, so It’s hard to be too dogmatic. But I don’t think personalized dietary counseling would be a bad thing for almost anyone.

Exercise isn’t quite as opaque. Still, we’d all benefit from individualized recommendations on the type/intensity/duration of exercise to optimize health.

Lastly, many people have no clue what constitutes a healthy weight. When I ask, most answers are 15-20+ pounds over high-end BMI estimates, and it isn’t because everyone has excess muscle mass.

 

[Terminalxylem]

Serious question - what percentage of people do you think genuinely don’t know the stuff you mentioned?

Not a medical provider ... but I would think lack of knowledge is almost never an issue with obesity.

Instead, it seems obvious (without medical training/schooling but as an obese person) that obesity is a multi-factorial affliction -- one's physiological makeup seems to have a large effect. Off the cuff, there also seems to be multiple distinct psychological components (e.g. pleasure-pain/reward 'system' is off or 'hijacked', exercise doesn't yield [sufficient?] endorphins, etc.).

I do know (or rather 'know', because there's likely to be well-supported contrary info out there) that there are a good number of people -- maybe 1 in 5 Americans, maybe more -- that could work out like a triathlete, live on kale, and go get lost in the Andes for a year ... and would still end up having what amounts to a 'Dad bod + beer gut'. And there are also some amount of people that could eat three Thanksgiving dinners every day, lie around on the couch binging Netflix 24/7, and they'd never put on an ounce -- instead, they'd feel nauseous all the time (and probably vomit more than they'd like) from all that excess food their body can't process in some manner (read: digest for nutrients or store as body fat).

Sigh.

Starting off obese ... and looking to get in some kind of quasi-shape ... that's a big freackin' mountain. It ain't just diet-&-exercise for a little while and you're good. Lifestyle changes? Forever? What? How many of us are really in for that? How many of us can really bootstrap that out of our psyches? And even if you can, you're pretty darned exceptional ... and can you really expect that one-in-a-jillion exceptionality out of all obese people?

Needless to say, there's a lot to work through before you even get to the 'diet & exercise' platitude. Bring on the drugs.

We’re generally on the same page, but I disagree strongly with most of this post. The vast majority of people aren’t slaves to their metabolism, and it doesn’t take a Herculean effort to improve one’s health.

That said, most diet and exercise programs ultimately fail, so we agree on one thing: bring on the drugs, at least to start the process.

 

[Scoresman]

I have fallen into the trap of just eating whatever I want when I'm feeling good, then when something starts to go wrong, or I get news/test results I dont like, it triggers me into eating healthy mode again. I know how to do it. I've lost 60 pounds before. But then I get complacent and it comes back.

I'm back in a healthy mode now because while my cholesterol is extremely low thanks mainly to statins (family history and stuff), I'm now prediabetic. I guess all the lowfat pastas and breads wasn't good enough. Now I have to eliminate more things I love.

Why do all of the things that taste so good end up being bad for you and vice versa? I thought evolution was supposed to take care of stuff like this. Didn't we evolve to make things like poisonous plants taste bitter or whatever? Why can't we hurry up and evolve to make a Whopper taste like butt?

 

[Terminalxylem]

I have fallen into the trap of just eating whatever I want when I'm feeling good, then when something starts to go wrong, or I get news/test results I dont like, it triggers me into eating healthy mode again. I know how to do it. I've lost 60 pounds before. But then I get complacent and it comes back.

I'm back in a healthy mode now because while my cholesterol is extremely low thanks mainly to statins (family history and stuff), I'm now prediabetic. I guess all the lowfat pastas and breads wasn't good enough. Now I have to eliminate more things I love.

Why do all of the things that taste so good end up being bad for you and vice versa? I thought evolution was supposed to take care of stuff like this. Didn't we evolve to make things like poisonous plants taste bitter or whatever? Why can't we hurry up and evolve to make a Whopper taste like butt?

You need to train your palate.

While sweet, salty and greasy are intrinsically appealing, if you consistently eat healthy foods, your preferences will change.

I love the taste of broccoli, beets and Brussels sprouts, for example. All of those were acquired tastes. It’s not too different from learning to love beer.

Also, if you avoid certain foods long enough, they lose their appeal. After growing up on burgers and fried chicken, I no longer crave them whatsoever. But that took several years of not eating meat.

That’s not to say you can extinguish all the tasty stuff. Still, its not difficult to transition to healthier choices imo.

 

[Scoresman]

I have fallen into the trap of just eating whatever I want when I'm feeling good, then when something starts to go wrong, or I get news/test results I dont like, it triggers me into eating healthy mode again. I know how to do it. I've lost 60 pounds before. But then I get complacent and it comes back.

I'm back in a healthy mode now because while my cholesterol is extremely low thanks mainly to statins (family history and stuff), I'm now prediabetic. I guess all the lowfat pastas and breads wasn't good enough. Now I have to eliminate more things I love.

Why do all of the things that taste so good end up being bad for you and vice versa? I thought evolution was supposed to take care of stuff like this. Didn't we evolve to make things like poisonous plants taste bitter or whatever? Why can't we hurry up and evolve to make a Whopper taste like butt?

You need to train your palate.

While sweet, salty and greasy are intrinsically appealing, if you consistently eat healthy foods, your preferences will change.

I love the taste of broccoli, beets and Brussels sprouts, for example. All of those were acquired tastes. It’s not too different from learning to love beer.

Also, if you avoid certain foods long enough, they lose their appeal. After growing up on burgers and fried chicken, I no longer crave them whatsoever. But that took several years of not eating meat.

That’s not to say you can extinguish all the tasty stuff. Still, its not difficult to transition to healthier choices imo.

Yeah, the bolded doesnt work for me. I've sworn off fast food, for example for months/years when dieting previously, yet the cravings never went away.

My dieting used to be focused on low fat items and portion control/counting calories and it used to work well. I love to cook and experiment in the kitchen so coming up with tasty recipes that worked while dieting was fun.

But now with the pre-diabetes, staples I used to rely on like low fat pastas or chicken and rice are off the table for the most part and it is proving to be much more difficult.

 

[Terminalxylem]

I have fallen into the trap of just eating whatever I want when I'm feeling good, then when something starts to go wrong, or I get news/test results I dont like, it triggers me into eating healthy mode again. I know how to do it. I've lost 60 pounds before. But then I get complacent and it comes back.

I'm back in a healthy mode now because while my cholesterol is extremely low thanks mainly to statins (family history and stuff), I'm now prediabetic. I guess all the lowfat pastas and breads wasn't good enough. Now I have to eliminate more things I love.

Why do all of the things that taste so good end up being bad for you and vice versa? I thought evolution was supposed to take care of stuff like this. Didn't we evolve to make things like poisonous plants taste bitter or whatever? Why can't we hurry up and evolve to make a Whopper taste like butt?

You need to train your palate.

While sweet, salty and greasy are intrinsically appealing, if you consistently eat healthy foods, your preferences will change.

I love the taste of broccoli, beets and Brussels sprouts, for example. All of those were acquired tastes. It’s not too different from learning to love beer.

Also, if you avoid certain foods long enough, they lose their appeal. After growing up on burgers and fried chicken, I no longer crave them whatsoever. But that took several years of not eating meat.

That’s not to say you can extinguish all the tasty stuff. Still, its not difficult to transition to healthier choices imo.

Yeah, the bolded doesnt work for me. I've sworn off fast food, for example for months/years when dieting previously, yet the cravings never went away.

My dieting used to be focused on low fat items and portion control/counting calories and it used to work well. I love to cook and experiment in the kitchen so coming up with tasty recipes that worked while dieting was fun.

But now with the pre-diabetes, staples I used to rely on like low fat pastas or chicken and rice are off the table for the most part and it is proving to be much more difficult.

This is where a dietician/nutritionist can help, as they should be able to provide suitable substitutes for the unhealthy parts of your diet.

And meds like Zepbound help with food cravings/satiety.

 

[Terminalxylem]

Hopefully, this doesn’t end up like covid vaccination, where people fear extremely unlikely side effects more than the more harmful diseases it prevents/treats.

This bears repeating, both for Zepbound and semaglutide formulations.

 

[Terminalxylem]

Not Ozempic, but drugs in the same class aren’t associated with bone fractures

Results: A total of 38 studies with 39 795 patients with T2DM were included. There were 241 incident bone fracture cases (107 in the GLP-1 RAs group and 134 in the control group). Compared with patients who received placebo and other anti-diabetic drugs, those who received GLP-1 RAs treatment showed a pooled OR of 0.71 (95% CI, 0.56-0.91) for bone fracture. Subgroup analysis showed that treatments with liraglutide and lixisenatide were associated with significantly reduced risk of bone fractures (ORs, 0.56; 95% CI, 0.38-0.81 and 0.55; 95% CI, 0.31-0.97, respectively). However, other GLP-1 RAs did not show superiority to placebo or other anti-diabetic drugs. Moreover, these beneficial effects were dependent on the duration of GLP-1 RAs treatment, only a GLP-1 RAs treatment period of more than 52 weeks could significantly lower the risk of bone fracture in patients with T2DM (OR, 0.71; 95% CI, 0.56-0.91).

Conclusions: Compared with placebo and other anti-diabetic drugs, liraglutide and lixisenatide were associated with a significant reduction in the risk of bone fractures, and the beneficial effects were dependent on the duration of treatment.

A more recent meta analysis, albeit from a less well known journal

Results: Based on the articles included, the animal studies indicated the salutary skeletal effects of GLP1RAs in opposition to what has been commonly observed in human studies, showing that these agents have no impact on bone mineral density (BMD) and the turnover markers. Moreover, it was demonstrated that GLP1 was not associated with fracture risk as compared to other anti-hyperglycemic drugs. Conclusions: Findings from this systematic review have demonstrated the neutral impact of GLP1RAs on BMD. Moreover, further double-blind randomized controlled trials are needed to draw more meaningful and significant conclusions on the efficacy of GLP1RAs on BMD.

 

[Terminalxylem]

Semaglutide and more severe GI side effects

Use of GLP-1 agonists compared with bupropion-naltrexone was associated with increased risk of pancreatitis (adjusted HR, 9.09 [95% CI, 1.25-66.00]), bowel obstruction (HR, 4.22 [95% CI, 1.02-17.40]), and gastroparesis (HR, 3.67 [95% CI, 1.15-11.90) but not biliary disease (HR, 1.50 [95% CI, 0.89-2.53]). Exclusion of hyperlipidemia from the analysis did not change the results (Table 2). Inclusion of GLP-1 agonists regardless of history of obesity reduced HRs and narrowed CIs but did not change the significance of the results (Table 2). E-value HRs did not suggest potential confounding by BMI.

Discussion
This study found that use of GLP-1 agonists for weight loss compared with use of bupropion-naltrexone was associated with increased risk of pancreatitis, gastroparesis, and bowel obstruction but not biliary disease.

They excluded patients with diagnosis codes indicating diabetes, or drugs being used for anti-diabetic effect. So unlike the bone stuff, there are legitimate concerns about severe GI side effects, although the absolute risk is small.

 

[Dr. Octopus]

Why can't we hurry up and evolve to make a Whopper taste like butt?

Once you get used to not eating crap like that, it does. On the rare occasion I do eat fast food I immediately feel sick to my stomach after.

On the flip side I now prefer nuts and fruits to chips or cookies as well.

 

[Pip's Invitation]

Why can't we hurry up and evolve to make a Whopper taste like butt?

Once you get used to not eating crap like that, it does. On the rare occasion I do eat fast food I immediately feel sick to my stomach after.

On the flip side I now prefer nuts and fruits to chips or cookies as well.

My wife has had pancreatitis since 2019. She has drastically reduced the fat in her diet and rarely eats red meat anymore. She says it tastes weird now and she has little to no desire for it.

 

[baymen]

I know 3 people closely that have been on eiher Wegovy or Moiunjaro for an extended period of time. Their weight loss has been amazing.

I have read that these drugs really hel[p with kidney function. Since I get gout a few times a year, I have been interested if this would help with that. I am not obese on the BMI scale so I am not sure if I qualify for a prescription.

 

[Terminalxylem]

Why can't we hurry up and evolve to make a Whopper taste like butt?

Once you get used to not eating crap like that, it does. On the rare occasion I do eat fast food I immediately feel sick to my stomach after.

On the flip side I now prefer nuts and fruits to chips or cookies as well.

Absolutely. But like quitting a lot of things, dropping the junk and eating healthily requires emotional and intellectual “buy-in” for it to work. If one approaches dietary change as punishment, and junk food as a reward, they’re unlikely to reach the point the palate changes.

That’s not to say all unhealthy food starts to taste terrible, but you get to the point eating it makes you fell unwell, and crave healthier options.

I wasn’t expecting any of that when I changed my diet decades ago, but I also didn’t close my mind to the possibility I could enjoy a plant based diet.

 

[Terminalxylem]

I know 3 people closely that have been on eiher Wegovy or Moiunjaro for an extended period of time. Their weight loss has been amazing.

I have read that these drugs really hel[p with kidney function. Since I get gout a few times a year, I have been interested if this would help with that. I am not obese on the BMI scale so I am not sure if I qualify for a prescription.

BMI greater than 27 and gout should qualify, as being overweight is a risk factor for gout. But your gout may or may not be related to kidney function.

 

[Jutz]

If this is a topic you are truly passionate about, I would highly recommend you watch this podcast: The Shocking Truth About The Obesity Crisis, Ozempic, ADHD & Food Industry Lies | Calley Means

It’s extremely long. I watched it and it made me mad. The short version… the Medical Community, big food corporations, Universities (like Harvard), Politicians, the Media, and Drug Companies are all working together and “rigging institutions of trust”. They are giving us bad info. Going to see a nutritionist sounds like a good idea, but if they are all trained to give us the same bad information it won’t help.

The truth is, the pharmaceutical industry and the healthcare industry at large… is the largest funder of government, it’s the largest funder of think tanks, it’s the largest funder of academic research, it’s the largest funder of news funding… it’s 50% of news funding. …they’re the largest funder of every single institution. They’re the largest funder of medical groups, they’re the largest funder of civil rights groups. The NAACP. So every group that we hold sacrosanct… Harvard, the NIH… the FDA… is more than 50% directly funded by the pharmaceutical industry. And then food (industry) is not far behind. So you literally have the core institutions that set our culture, that set the guidelines, their bills are paid by pharma.

My personal experience… I lost about 40 lbs. because I started walking more and stopped eating what I describe as ‘horribly’. As in fast food and Chinese buffets nearly every day. After I lost 40 lbs. I was stuck. My BMI scale was still ‘Overweight’. I tried eating less… exercising more. I did it for about 6 years. It didn’t work. I was on the weight loss rollercoaster. Eventually, through curiosity and realizing that I need to do something different, I went on a carbohydrate restricted ketogenic diet. I lost 20-25 pounds more in about 6 – 12 months. A year and a half later, it is still off. Will it work for you? I have no idea. All I would say is, try it and find out? It has been successfully used to reverse obesity, type 2 diabetes, and a variety of metabolic diseases for 20 years. I have come to the conclusion that the main reason it worked for me is that I cut down extremely on sugar and highly processed foods. A vegan diet does the same thing and works for a lot of people.

I completely agree with @massraider on this one. It ain’t gonna fix ****. If you go to the 25 minute mark:

The big problem with Ozempic is that literally hand in hand with the Ozempic argument is this idea that obesity is genetic, that obesity is this disease that you can’t really… control. That it’s a thing that you need to manage for the rest of your life. A 6 year old put on Ozempic… the instructions for the drug is that they need to take that injection for the rest of their lives. And you actually get, and have doctors on 60 minutes saying… don’t worry, throw willpower out the window. You can manage this with a drug. The criminal part for our country is that… that kid is going to have a more tortured life. If that kid is ingesting hormone disrupting, toxic, inflammatory food. And not learning how to exercise. Not learning how to eat healthy. They’re going to live a less optimal life. They’re going to live a more depressed life.

 

[Jutz]

EU expands Wegovy, Ozempic probe over suicide risks to include other weight loss, diabetes drugs